PHENOTYPING

Red cell phenotyping is performed to confirm the presence or absence of particular

antigens, using commercial reagent anti-sera / cards. In general a patient will only
develop a particular red cell allo-antibody if they lack the corresponding antigen on
their own red cells. To ensure safe transfusion antigen negative donor units
(confirmed by phenotyping) are generally required if patients have clinically
significant antibodies in their plasma.

Patient RBC Phenotyping

 Patients are phenotyped for particular antigens on the first occasion an antibody is
detected. The patient should be confirmed as "negative", for the antigen against
which they have an antibody.
 Where practical, patients also should be phenotyped for the alternative allele
(phenotyping in pairs), as a means of quality assurance as the red cells are
expected to be positive for one or other antigen.
Eg: Patient with anti-Jka is phenotyped using reagent anti-Jka and reagent anti-Jkb
(Jka & Jkb are allelic). We expect that the patient will be negative for the "Jka"
antigen but positive for "Jkb" (Jka-b+). If not it is likely that something is amiss (or
you have a rare Jk (a-b-) phenotype. Exception to this rule is testing of MN
phenotypes. N phenotype is only recommended if there is a new Anti-N detected and
testing as part of PARTNER testing (Ante-natal).
 For patients with an Rh antibody, a complete Rh/K phenotype is performed
(C,c,D,E,e). Use the Grifols Rh card for patient Rh phenotypes.
 For patients with a clearly clinically significant antibody (Rh, K, k, Fya/b, Jka/b,
S, s), a complete Rh/K phenotype should be performed
 All new Haematology patients are automatically Rh/K phenotyped before they are
transfused.
 Extended phenotypes are performed for patients at high risk of developing
alloantibodies (eg Thal major and Sickle patients) for the following antigens CcEe
Kk Fya/b Jka/b MSs.
 A patient phenotype may be unreliable if there is a recent transfusion history (3
months). As circulating donor cells may cause mixed field reactions resulting in a
false positive or negatives.
 Only patients who are DCT Negative can be reliably phenotyped unless the
method does not detect the associated autoagglutination. Autoagglutination can
cause false positive patient results. To exclude false positive results ensure that
patient cells are negative with a suitable autocontrol. IgM monoclonal reagents are
chosen where autoagglutination may be a problem.
 To avoid false positive interpretations - Ensure red cells are Direct Coombs
(DAT) negative for methods involving Indirect Antiglobulin testing, .
 Request a phenotyping test (PHE.) if patient phenotyping is required to be
performed.
 Controls are recorded on Phenotyping database

Donor Unit Phenotyping

 Donor units selected for crossmatch need to be antigen negative whenever a
patient has a clinically significant antibody (see Pretransfusion Testing Policy).
 Blood Service phenotyped donor units have a donor phenotype label on the blood
pack. Antigen negative packs can be selected from stock, or ordered from the
Blood Service Dispatch Department Confirmation of negative antigens by the
laboratory only needs to be carried out if the patient has an antibody present or has
a previous history of significant antibodies. The use of prophylactic matched
donor phenotypes for patients (such as sickle and thalassemia patient) without
antibodies or without a history of significant antibodies do not require
confirmational phenotypes to be carried out. The use of the electronically
transferred information from BloodNet to Cerner allows us to be able to record
that the patients are receiving the appropriate phenotype. Do not mark packs or
write directly on pack label with texta or pen.
 Untyped stock packs can also be typed using commercial phenotyping reagents.
The probability of obtaining antigen negative packs should be checked against an
antigen frequency table (eg CSL Blood Group Reference Guide). Avoid typing for
high frequency antigens.
 Ensure red cells to be tested are Direct Coombs (DAT) negative for methods
requiring Indirect Antiglobulin testing to avoid false positive interpretations.
 Phenotyping on products requires an order on Cerner “Product Orders” for each
product typed
 Controls are recorded on Phenotyping database

Donor Units for Patients with Rh antibodies;

Blood selected for crossmatch is Rh matched to avoid the stimulation of undetected
Rh antibodies. If the sensitized patient is negative for antigens C, c, E, or e then the
donor units should also be negative for those antigens. Grifols cards will provide a
full Rh type.
Eg. A patient with anti-E who is CDe (R1R1) should receive R1R1 blood (c-, E-).
A patient with anti-E who is CcDe (R1r) need only receive E- blood (R1R1 or R1r is
OK)
 Donor Units for Patients with Low Incidence and Clinically Insignificant
antibodies
Patients with antibodies against Anti-Cw, Anti-Kpa, Anti-N, P1, Lewis, Lutheran (a),
leucocyte, HTLA and cold antibodies, need not be antigen negative, just crossmatch
compatible by an IDC method.

If antibody is identified as clinically significant, units must also be antigen negative

(refer to Patients with Antibodies – Specificity & Clinical Significance

HENOTYPING METHOD - GRIFOLS CARD (Rh & K)

Purpose & Principle:

To determine the presence or absence of Rh or K antigens on patient red cells donor
red cells using manufactured cards predispensed with antisera.

Equipment & Reagents:

 Glass Tubes
 Rainin EDP Pipettor or Picus pipettor and Tips
 Diluent Dispenser
 Grifols DGSpin Centrifuge
 Card – Grifols Rh card (7125) or Grifols K card (7123)
 Diluent – Grifols Gel Sol.
 Grifols DG Reader (for manual method)
 Grifols WA Diana/Shuttle ZIP (for automated method)
 Specimen
Patient: Specimen can be either EDTA-anticoagulated or clotted blood, and need be
checked, labelled, centrifuged as described in Specimen Request Requirements
Donor Cells: Anticoagulated donor unit line segments: express contents into a glass
tube and centrifuge in Spin 12 Centrifuge

Safety Precautions:
The use of Eye Protection, Gloves, Gowns and Safety Footwear are mandatory to
perform this method.
All products derived from human blood should be considered potentially infectious

Controls:
Positive and Negative controls are not required for the Rh and K phenotyping card.
They are tested on receipt and at 3 monthly intervals thereafter. At preacceptance
testing or for retesting at 3 monthly intervals - record controls in Phenotype Control
database.
Automated Gel Card Test Method:
Preparation of Red Cells
Use centrifuged patient, donor or control red cells (minimum volume 250uL)

Method Summary (automated)

Remove lid and load centrifuged sample onto Grifols Instrument (Erytra, Eflexis, WA
Diana or Shuttle ZIP) load cards and select test profile.
 Manual Gel Card Test Method Anti-K:
Preparation of Red Cells
Make a 1% suspension of red cells in Gel Sol. 1% suspension can be prepared using
10ul of red cell concentrate in 1ml of Gel Sol. Some adjustment may be necessary if
cells are not sufficiently packed.
Grifols Gel Sol . Store at 2-6oC. Ensure that the diluent is within expiry and has been
opened no longer than 4 days ago.

Method Summary (manual)

 Add 50ul of 1% red cell suspension to a labelled well of the K card
 Centrifuge card in DGSpin centrifuge and read on Grifols DG Reader

Manual Method DG Gel Rh Pheno:

Preparation of Red Cells
Make a 5 % suspension of red cells in Gel Sol. 5% suspension can be prepared using
50ul of red cell concentrate in 1ml of Gel Sol. Some adjustment may be necessary if
cells are not sufficiently packed.
Grifols Gel Sol . Store at 2-6oC. Ensure that the diluent is within expiry and has been
opened no longer than 4 days ago.

Method Summary (manual)

 Add 10ul of 5% red cell suspension to each of the 4 wells of the Rh card
(corresponding to the C,E, c, e wells)
 Centrifuge card in DGSpin centrifuge and read on Grifols DG Reader
 Results:
Images on DG Reader or WA Diana/Shuttle are reviewed prior to printing and
sending.
If all wells are positive consider the possibility of autoagglutination

Result Interpretation:
Positive
Red cell agglutinates forming a line or band at the top of the gel matrix or dispersed
throughout the gel column indicates that the antigen is present. For manual override of
reader’s results refer to reference "Grading Cards".
Negative
Button of red cells at the base of the column with no visible agglutination in the gel
matrix indicates the antigen is absent from the red cells
Double Population
A double population of cells ie negative and positive in the same well indicates more
than one population of cells present (eg transfused patient)

Limitations of the Test:

Autoagglutination
If all wells are positive do not accept results unless cells are DAT negative. Use of a
tube technique may be a valid alternative.
Samples
Do not use haemolysed, cloudy or contaminated samples, or samples with clots
present.
Do not use samples from patients transfused in the last 3 months.
Reagents & Cell Suspensions
Reagents must be in date and be checked for visible abnormalities and accepted
before use.
Cell suspensions that are too heavy may cause false positives
Cell suspensions that are too weak may cause false negatives

Reference
Grifols Reagent Insert

PHENOTYPING METHOD – GRIFOLS BOTTLE REAGENT + CARD

Purpose & Principle:

To determine the presence or absence of specific antigens on patient or donor red cells
using bottled Grifols antisera on Grifols cards. All sectors should have Grifols anti-
Fya, Fyb, Jka, M, S . Other antisera are infrequently required and if needed can be
performed at Liverpool or antisera transported from Liverpool when needed. These
reagents are generally available as stock to sector laboratories
Refer to Availability of Red Cell Phenotyping Reagents table (below)

Equipment & Reagents:

 Glass Tubes
 Rainin EDP Pipette or Picus pipette and Tips
 Diluent Dispenser
 37oC Card Incubator
 Grifols DGSpin Centrifuge
 Bottled Phenotyping Reagent - Grifols
 Card –Grifols AHG card
 Diluent – Grifols Gel Sol Store at 2-6oC. Ensure that the diluent is within
expiry and has been opened no longer than 4 days ago.

Specimen
Patient: Specimen can be either EDTA-anticoagulated or clotted blood, and need be
checked, labelled, and centrifuged as described in Specimen Request Requirements
Donor Cells: Anticoagulated donor unit line segments: express contents into a glass
tube and centrifuge in Spin 12 Centrifuge

Safety Precautions:
The use of Eye Protection, Gloves, Gowns and Safety Footwear are mandatory to
perform this method.
All products derived from human blood should be considered potentially infectious

Controls:
Positive and Negative controls are run with each batch of tests.

Positive controls are selected to express weak expression of antigen (eg heterozygous)
and must always give results stronger than 1+ strength.

Positive and Negative control results for the batch number of the reagent used are
recorded on the Phenotype Control database. . Previous results on the database can be
used to compare with current results to assess viability of the reagent in use. It should
also be possible to determine which batch was used for any patient based on the staff
ID and date of test on Cerner and the database. The control results may also be
recorded as part of the patient’s phenotyping result record on Cerner .
 Manual Test Method Grifols - Bottle Reagent 1:
Preparation of Red Cells
Use a 0.8% suspension of red cells in Gel Sol. 0.8% suspension can be prepared using
10ul of red cell concentrate in 1ml of Gel Sol. Some adjustment may be necessary if
cells are not sufficiently packed.

Method Summary
Antiserum (polyclonal) Card 0.8% Red Antiserum Incubation Time &
Cell volume Temperature
Fya,Fyb, Kpa,Kpb, AHG 50uL 10uL - 25uL 15 minutes at 37oC
k(cellano), Lua,Lub, S,s

M, N, Neutral Gel 50uL 10uL - 25uL No Incubation

After Incubation centrifuge card in DGSpin centrifuge and read using DG Reader

Result Interpretation:
Positive
Red cell agglutinates forming a line or band at the top of the gel matrix or dispersed
throughout the gel column indicates that the antigen is present. Positive results are
graded according to reference "Grading Cards".
Negative
Button of red cells at the base of the column with no visible agglutination in the gel
matrix indicates the antigen is absent from the red cells
Double Population
A double population of cells ie negative and positive in the same well indicates more
than one population of cells present (eg transfused patient)

Limitations of the Test:

Autoagglutination
If all sample tubes are positive consider whether the cells may be autoagglutinating
Samples
Do not use haemolysed, cloudy or contaminated samples, or samples with clots
present.
Do not use samples from patients transfused in the last 3 months.
Reagents & Cell Suspensions
Reagents must be in date and be checked for visible abnormalities and accepted
before use.

1
Wallchart x1
Incorrect Incubation Time and Temperature may cause false positive or false negative
results
Cell suspensions that are too heavy may cause false positives
Cell suspensions that are too weak may cause false negatives

Reference
Grifols Reagent Insert
 PHENOTYPING METHOD – OTHER BOTTLED ANTISERA +TUBE

Purpose & Principle:

To determine the presence or absence of specific antigens on patient or donor red cells
using bottled antisera by tube technology. These reagents are generally unavailable as
stock to sector laboratories, if required the sample can be referred to Liverpool or the
reagent transported to sector lab on loan.
Refer to Availability of Red Cell Phenotyping Reagents table (below)

Equipment & Reagents:

 Glass Tubes
 37oC Water Bath
 Immufuge Centrifuge
 Bottled Phenotyping Reagent – as required
 Normal Saline 0.9% (unbuffered)
 Transfer Pipette – plastic
 Reagent red cells 3% (as appropriate for controls)

Specimen
Patient: Specimen can be either EDTA-anticoagulated or clotted blood, and need be
checked, labelled, centrifuged as described in Specimen Request Requirements
Donor Cells: Anticoagulated donor unit line segments: express contents into a glass
tube and centrifuge in Spin 12 Centrifuge

Safety Precautions:
The use of Eye Protection, Gloves, Gowns and Safety Footwear are mandatory to
perform this method.
All products derived from human blood should be considered potentially infectious

Controls:
Positive and Negative controls are run with each batch of tests.

Positive controls are selected to express weak expression of antigen (eg heterozygous)
and must always give results stronger than 1+ strength. Use manufactured 3% reagent
red cells.

Positive and Negative control results for the batch number of the reagent used are
recorded on the Phenotype Control database. Previous results on the database can be
used to compare with current results to assess viability of the reagent in use. It should
also be possible to determine which batch was used for any patient based on the staff
ID and date of test on Cerner and the database. The control results may also be
recorded as part of the patient’s phenotyping result record on Cerner
 Tube Test Method:
Preparation of Red Cells
Add 0.9% saline to a drop of sedimented red cells to a final cell suspension of 3%.
For controls use 3% manufactured reagent red cells
Method Summary2
Antisera Manufacturer Method Summary Positive Control
C,c,E,e,Cw, Immulab 1 drop reagent r’r, r”r or Cw+ or
1 dr. 3% cells Kk
(monoclonal) 5 min 37oC Inc
20 High Immufuge
Macro read
M,N BioRad 1 drop reagent MN
1dr. 3% cells (heterozygous)
(monoclonal) 30min. Room Temp Inc
Gently dislodge cells- Read Macro
A1 Immucor 1 drop reagent A1 & A2
1 dr. 3% cells
(lectin) 2min. RT Inc.
20s Low Immufuge & Macro read
S, s Immulab 1 drop reagent Ss (heterozygous)
1 dr. 3% cells
(Monoclonal) 20 High Immufuge & Macro read
Note Anti-S only: incubate negatives 5min RT
& respin (not for anti-s)
P1 Immulab 1 drop reagent P1+ (weak)
1 dr. 3% cells
(monoclonal) 20s High Immufuge & Macro read

Lea, Leb BioRad 1 drop reagent Lea+b-, Lea-b+

1 drop 3% cells
Lea 15 min RT Inc, Leb 15-30 min RT Inc
Lea 10s High Immufuge & Macro read
Leb 20s High Immufuge & Macro read
Lea, Leb Grifols 1 drop reagent Lea+b-, Lea-b+
1 dr. 3% cells
5 min RT Inc
20s Low Immufuge & Macro read
Jka, Jkb Immulab 1 drop reagent Jk(a+b+)
1 dr. 3% cells
Spin 60s Low Immufuge & Macro read

2
Wallchart x5
Result Interpretation:
Agglutination of similar or higher grading compared to positive control indicates
presence of antigen

Agglutination should be graded as follows:

4+ One solid clump

3+ Large to medium-sized clumps, clear background
2+ Small clumps, turbid background
1+ Grainy. Microscopically: clumps & free cells
Wk Microscopically small clumps and free cells
0 Free cells, an occasional tiny clump may be seen
* Negative reactions should be recorded as either "neg" or "0"

Limitations of the Test:

Autoagglutination
If all sample tubes are positive consider whether the cells may be autoagglutinating
Samples
Do not use haemolysed, cloudy or contaminated samples, or samples with clots
present.
Do not use samples from patients transfused in the last 3 months.
If using samples likely to auto-agglutinate (eg strongly DAT positive) always run a
negative patient control (patient cells added to a neutral gel or AHG card)
Reagents & Cell Suspensions
Reagents must be in date and be checked for visible abnormalities and accepted
before use.
Incorrect Incubation Time and Temperature may cause false positive or false negative
results
Cell suspensions that are too heavy may cause false positives
Cell suspensions that are too weak may cause false negatives

Availability of Red Cell Phenotyping Reagents table

Antigen Supplier Sector Donor typing

Availability
 Anti-C,c,E,e Use Grifols Rh Yes
card
Anti-K Use Grifols K Yes
card
Fya, Fyb Use Grifols Yes
antisera
Jka Immulab Yes
Jkb Immulab- No
Liverpool only
Anti-M Grifols/BioRad Yes
Anti-N               BioRad No Not required for donor
typing or pair
phenotype testing.
Anti-S Use Grifols Yes
antisera
Anti-s Liverpool only No
Anti-Lea, Leb, Liverpool only No Not required for donor
P1 typing
Anti-Cw Liverpool only No Not required for donor
typing
Anti-Kpa Liverpool only No Not required for donor
typing

References
Reagent inserts from respective manufacturers

PHENOTYPE CONTROL DATABASE

The Phenotype database is used by all SWSLHD staff to record the results of positive
and negative controls for antigen phenotyping. Controls must be recorded in this
database each time the reagent is used (unless the same staff member is retesting on
the same day). The control results for a specific patient (accession number), or donor
units crossmatched for a specific patient (via accession number), are traceable by
staffID and date performed.

Preacceptence testing controls performed before the reagent is released are also
recorded in the database – this will be the first entry for that batch.
Main Menu

Phenotype Controls Rh card

Rh and K card controls are only recorded
with preacceptance testing and each 3
months thereafter (at each site).
 <Enter Rh Card Control Result>
from Main menu
 Enter <StaffID> and <RhBatch>
 Enter control results for R1R1, R2R2,
rr (screening cells) & R1R2 (donor
pack)
 <Exit to Menu and Reports>
Other Phenotype Controls
All other reagents must have controls
performed each time they are set up
(unless setup on the same day by the same
person).
 <Enter Other Phenotype Controls>
from Main menu
 Enter <StaffID> and <Batch#> (only
batches that have been pre-
registered will be listed)
 Enter <Method> (card or tube)
 Enter pos & neg control results
 Enter Accession Number
 <Exit to Menu and Reports>
Preacceptance completed will be preticked
Receiving Batches (Liverpool only)
This function is only used as batches are
received at LIV from the vendor.
Note: If the batch is new/unknown it will have
to be Registered first
 Assuming batch has been received on
other occasions – enter/select <Batch
Number> from list
 Only modify date received if backdating
 If batch is new/unknown it will need to
be registered first -select <Register
Unknown Batch>
 Close the data box (click “X”)
Register New Batches (Liverpool Only)
If the batch is new/unknown this function will
register it so it can be “Received”.
 Accessed from Receiving Batches
<Register Unknown Batch> button
 Also accessed from Main Menu
<View/Register Batch> - this will display
the list of current registered batches and
it has a <Register New Batch> button
 The Register New Batch data box will be
displayed
 Select Manufacturer and Antigen
 Enter Batch Number (numbers only – no
dots, dashes, spaces or leading zeros)
 Enter Expiry Date
 Only retrospectively tick <Preacceptance
Complete> checkbox if testing has
already been completed
Results / Reports
Access from Main menu <Results/Reports>
 Select either <Rh Card> or <Kcard> to
view results by batch
 Select <Other Antisera Results> and
choose antigen to view report by
antigen and batch number
 Select <Batch Enquiry> to view various
reports about a batch
Batch Records
Batch Recently Received
Batch Requires Preacceptance
Batch Recently Expired
Batches Received

CERNER ENTRY - PHENOTYPING –

Patient Phenotyping for Rh&K Antigen Set (RhKPHE)

 The order is placed in DOE as “RhKPHE.” This will place an order for 2
procedures –
 Rh Phenotyping and Red Cell Phenotyping
 Go to Result Entry
 Accession Number Mode
 Test Group = “Pheno”
 Enter the Accession Number and check patient details
 A prompt box will appear for “PHE.” prompting for the number of cells to be
used in the Red Cell Phenotype procedure. This is for the Kell result only so
select “Pat. Pheno 1”
Note: Pat.Pheno cells must be chosen when phenotyping patients

 Both procedures will load into the Result Entry screen

 Enter results for the “RhPHE” procedure (Anti-C, Anti-E, Anti-c, Anti-e,
Anti-D). The system will perform the interpretation.
 The “Pheno. Comment” DTA is reserved for reporting any additional pertinent
information. This comment is chartable and viewable at ward level. It is
commonly used when reporting Antenatal partner phenotypes.
 Proceed to the “PHE.” resulting row. The “Pheno.Comment” is as above and
does not need to be resulted if already resulted on the Rh procedure. The
“Tube/Card” DTA is used to denote the method used for Kell typing. Enter
“Tube” or “Card”as appropriate. The “Result” DTA is the actual result
obtained for the phenotype (0, 1+, 2+ etc). Enter as appropriate. The
“Phenotype” DTA is the actual phenotype (K- or K+)
 Check and verify the results
 The antigens will be written to the patient’s history
 Patient Phenotyping (other than Rh)
 The order is placed in DOE as “PHE.”
 Go to Result Entry
 Accession Number Mode
 Test Group = “Pheno”
 Enter the Accession Number and check patient details
 A prompt box will appear for “PHE.” prompting for the number of cells to be
used in the Red Cell Phenotype procedure. Calculate the number of
phenotypes that you will be resulting and select the equivalent cell group.
Eg 1. if phenotyping for Fya, Fyb you will need 2 result cells so choose Pat. Pheno 2
Eg 2. if phenotyping for Fya, Fyb and K you will need 3 result cells so choose the cell
group that most closely accommodates the number of result cells required. You can
choose Pat.Pheno 2 and add an additional cell once in Result Entry or choose Pat
Pheno 4 and delete the extra row when in Result Entry.
Note: Pat.Pheno cells must be chosen when phenotyping patients
 The procedure loads into Result Entry
 The “Pheno. Comment” DTA is reserved for reporting any additional pertinent
information. This comment is chartable and viewable at ward level. It is
commonly used when reporting Antenatal partner phenotypes.
 The “Tube/Card” DTA is used to denote the method used for Ag typing. Enter
“Tube” or “Card” as appropriate. The “Result” DTA is the actual result
obtained for the phenotype (0,1+,2+ etc). Enter as appropriate. The
“Phenotype” DTA is the actual phenotype
o (eg. Fya-,Fyb+)
 To add additional resulting cells, place the cursor in the next available grey
cell in the “Tube/Card” DTA column. Click on the “Insert” icon on the icon
toolbar. A prompt box appears which prompts for whether you are inserting a
“cell” or “interp”. Select “cell”. The Cell Group prompt box appears. Select
the cell group which most closely accommodates the extra number of result
fields required. Eg. Pat. Pheno 1. Enter results as appropriate.
 Any extra blank cells can be removed by removing the entire associated row
before verifying the results
 Check and verify the results
 The antigens will be written to the patient’s history

Patient Full Phenotype

 The order is placed in DOE as “PHE.”
 Go to Result Entry
 Accession Number Mode
 Test Group = “Pheno”
 Enter the Accession Number and check patient details
 A prompt box will appear for “PHE.” prompting for the number of cells to be
used in the Red Cell Phenotype procedure. Enter “Pat. Full Pheno”
  The procedure loads into Result Entry
 The “Pheno. Comment” DTA is reserved for reporting any additional pertinent
information. This comment is chartable and viewable at ward level. It is
commonly used when reporting Antenatal partner phenotypes.
 The “Tube/Card” DTA is used to denote the method used for Ag typing. Enter
“Tube” or “Card” as appropriate. The “Result” DTA is the actual result
obtained for the phenotype (0,1+,2+ etc). Enter as appropriate. The
“Phenotype” DTA is the actual phenotype
 (eg. Fya-,Fyb+)
 Also record the results on the Phenotyping template form (See Blood Bank
Forms Manual)
 Once all results have been entered, PERFORM the results and leave the
Phenotyping form in the checking tray. A second person will check these
results against what is entered in Cerner. The second person will then
VERIFY the results
Note: HEA Genotype results are recorded on Cerner in a similar way except that
Tube/Card DTA is left blank and a phenotype comment is added indicating HEA
Genotype performed by Red Cross (Qxxxxx)
 Unit Phenotyping
NOTE: Prior to ordering and resulting unit phenotypes, check that the unit has not
already been phenotyped for the antigen. This can be done by viewing the ‘Special
Testing’ box in “Product History”. Resulting duplicate unit phenotypes will lock the
unit and will requires unlocking by Pathnet team.

 Phenotyping procedures on products need to be ordered via the “Product

Orders” application
 Go to Product Orders
 In the “Procedure” field enter “Red Cell Phenotyping”
 Enter the Product Number/s
 Press Save
 This completes the order process.

 Go to Result Entry
 Product Number Mode
 Test Group = “Pheno”
 Enter the Product Number
 A prompt box will appear for “PHE.” prompting for the number of cells to be
used in the Red Cell Phenotype procedure. Calculate the number of
phenotypes that you will be resulting and select the equivalent cell group.
Eg 1. if phenotyping for Fya, Fyb you will need 2 result cells, so choose Unit
Pheno 2
Eg 2. if phenotyping for Fya, Fyb and K you will need 3 result cells so choose the
cell group that most closely accommodates the number of result cells required. You
can choose Unit Pheno 2. and add an additional cell once in Result Entry or choose
Unit Pheno 4 and delete the extra row when in
Eg3. If phenotyping units for R1R1 (c-E-) you will be testing with anti-c & anti-E
and you will need 2 result cells, choose Unit Pheno 2. Do not try to use combined Rh
pheno this is for patients only.
 The “Pheno. Comment” DTA is reserved for reporting any additional pertinent
information. This comment is chartable and viewable at ward level. It is
commonly used when reporting Antenatal partner phenotypes. It is not
resulted when phenotyping units.
 The “Tube/Card” DTA is used to denote the method used for Ag typing. Enter
“Tube” or “Card” as appropriate. The “Result” DTA is the actual result
obtained for the phenotype (0, 1+, 2+ etc). Enter as appropriate. The
“Phenotype” DTA is the actual phenotype
o (eg. Fya-,Fyb+)
 To add additional resulting cells, place the cursor in the next available grey
cell in the “Tube/Card” DTA column. Click on the “Insert” icon on the icon
toolbar. A prompt box appears which prompts for whether you are inserting a
“cell” or “interp”. Select “cell”. The Cell Group prompt box appears. Select
 the cell group which most closely accommodates the extra number of result
fields required. Eg. Unit Pheno 1. Enter results as appropriate.
 Any extra blank cells can be removed by removing the entire associated row
before verifying the results
 Check and verify the results
 The antigens will be written to the product’s history
 Cancelling Patient Phenotype Orders
Orders may be cancelled in DOE following the routine procedure
 Go to Accession Add-on and enter the Accession Number

 Click on the ‘Cancel Orders’ icon

 The system displays all orders available for cancellation
 Select the order you need to cancel ensuring that the Accession Number
matches
 The system will display ‘Cancel Reason’, ‘Cancelling Physician’, ‘Cancel
Date/Time’ and ‘Cancel Communication Type’ boxes
 The user needs to select an appropriate cancel reason from the drop down list
 If the test is cancelled for laboratory protocol reasons, the cancelling physician
should be entered as “Harvey M”
 The Cancel Date/Time and Communication Type fields can be left with the
default information

Cancelling Unit Phenotype Orders

Orders may be cancelled in DOE following the routine procedure
 Go to “Product Orders”
 Select “Task”
 Select “Cancel Orders”
 Enter the Product Number
 The system will display all orders on the product which are available for
cancellation
 Select the order/s you wish to cancel by ticking the box at the left of the row
 Multiple orders can be selected for cancellation
 Press ‘Save’ icon

Rare Unit Phenotyping performed by REDX

Occasionally it will be necessary to order blood from Red Cross which has been typed
for rare antigens eg Vel -ve. In these cases do as follows –
Before any crossmatching is performed in Cerner –
 The person who is performing the crossmatch will visually check the pack
label for phenotype
 Go to Correct Inventory/Special Testing
 Select the appropriate phenotype (eg. Vel-ve) from the list of ‘Available’
values in the left hand side box and ‘Move’ the value to the right hand side
box
  Go to the Comment icon on the icon toolbar and enter an
appropriate comment then press ‘OK’, then ‘Close’. This
comment will remain with the product’s history

 Press ‘Save’ icon.

 You will be presented with an exception box to give a reason
– Use ‘Adjust Inv.’